Although technology can be helpful, there’s no substitute for the human touch.
One wintry evening at Wales Home, an independent living residence and long-term care community in Quebec, a 90-year-old resident slipped and fell on ice while trying to connect an engine block heater for his car to an outdoor electrical outlet. Had he not been spotted minutes later by the facility's executive director leaving for home, the man likely would have remained there in sub-zero weather for the next four hours until shift change.
Unwilling to tempt fate again, the facility soon invested in new real-time location system (RTLS) technology — in this case a bracelet with an emergency call button — to replace the 95-year-old facility's call bell system on nine linked alarms activated by pull chain.
Whether senior living residents fall or amble off during the day or at night, by accident or on purpose, their unmonitored and untethered movements are the stuff of restless evenings for so many administrators and directors today.
But thanks to RTLS and a host of innovative technology, from invisible sensors to radio frequency tags, the issue of elopement now has the potential of being a thing of the past.
“Safety and security have always been top priorities in the long-term care setting,” says James Jansen, product manager for Direct Supply Technology Solutions. “But with recent local and global events, more diagnoses of dementia and the reality of ongoing staffing challenges, security has become even more top of mind. There is also more visibility into and exposure of safety risks and breaches than ever before.”
Still, wandering remains high on the list of greatest risks in so many communities, particularly as more and more seniors fall victim to dementia. Even those without such a diagnosis can easily become agitated and confused under adverse conditions.
Memory care inspired
Approximately 60% of older adults with dementia are wandering candidates, according to the Alzheimer's Association.
Paul Larson, vice president of new product development and engineering services at RF Technologies, believes some of the most significant innovations have sprung specifically out of the memory care industry. “Memory care has seen huge advances in safety,” Larson says. “Fully monitored solutions utilizing discrete wireless transmitters help ensure that patients with dementia or memory loss don't elope from the community. Coverage of defined outdoor spaces now is relatively easy to achieve, and global positioning system (GPS)-enhanced solutions are one of the most significant game-changers that we see coming soon.”
Incubators in play
Engineers have been busy innovating the past few years, thanks in large part to the Internet of Things. Real-time locations, for example, is made possible because of the integration of GPS tech online.
“The senior living market has gone through a tremendous evolution in the last decade, and care communities are partnering more and more with technology companies to deliver safety and security for their residents,” adds Larson, pointing to innovations such as the wireless call pendants.
Perhaps one of the biggest incubators in senior living is the Evangelical Lutheran Good Samaritan Society, the nation's largest not-for-profit provider of senior care services. For many years, vendors have sought out the organization (and vice versa) to test emerging technologies and, in some cases, try ideas that sprouted from inside the walls of the organization itself.
“We take on an incubator role often. It's an interesting dance,” says Kelly Soyland, director of innovation and research, and the organization's Vivo: Innovation for Well-being Center. The organization has long worked with various vendors, from well-known brands to startups. A major project underway at press time involved activity monitoring and wearables. Soyland says the Society has been on a remote monitoring path for more than a decade, beginning at the University of Virginia Medical Automation Research Center. Ultimately, Soyland is hopeful its work will generate federal funding for remote monitoring.
“Safety and security solutions for senior living have certainly come a long way, taking advantage of a range of new technologies,” says Steve Elder, senior marketing manager for Stanley Healthcare, which markets the RTLS device Wales Home uses.
Elder points to three recent developments along wandering tech's evolutionary path: mobile protection (“a far cry from the days of fixed call stations”); customized protection, which stores and analyzes movements and behaviors to shape staff awareness and allows, for example, “access to areas like an enclosed Alzheimer's garden at certain times of the day but not others”; and tech integration, which allows things such as e-call and nurse call, wander management, fall monitors, access control and fire panels to be consolidated into a single system for easier management and reporting purposes — in most cases, via mobile phones.
Fuzzy robots, anyone?
The past several years have been a watershed in wandering tech. Recent innovations have been so effective, they have arguably hastened the drastic reduction in the use of antipsychotics while exposing some of the drawbacks of “old-school” solutions such as door alarms, restraints and even video cameras.
As Centrak Marketing Coordinator Josette Weinstein argues in a recent case study, video surveillance now permitted in assisted living facilities in six states is an outdated technology. “Unless you have a staff member watching camera feeds 24/7, it's impossible to know in real time when hazardous situations are occurring,” Weinstein says. Centrak provides RTLS solutions.
Even as innovation continues briskly, there seems to be no end to the kinds of gadgets and gizmos — some of them quirky but effective — that are flooding the market. Among them are GPS-enabled shoes, a fuzzy robotic pet designed to ease dementia-fueled anxiety and a quarter-sized radio frequency identification button a teenager recently patented in the course of his mission to find a cure for Alzheimer's disease.
Invisible motion sensors
Back in the year 2000, the elderly mother of Marilyn Rantz, Ph.D., RN, FAAN, fell in her home. For eight agonizing hours, the woman lay on the floor unable to move, suffering from a shoulder fractured in 13 places as she looked frustratingly at a wearable “911” alert pendant necklace she had removed and placed on a table earlier in the day.
The event was an epiphany for Rantz, a University of Missouri professor who spent the next 16 years studying, researching and developing a plethora of remote sensor technologies to measure gait, behaviors and movements of all kinds. Earlier this year, Rantz and her team successfully proved their sensors that are embedded in the floors, beds, walls and furniture in seniors' own homes could reliably predict falls with an 85% certainty. The Aging in Place Project also has been able to demonstrate a doubling of the length of stay with RN care coordination and another doubling with the sensor technology developed over the years.
As treacherous as the outside world is, wandering inside the walls of a secure facility can be fraught with danger, and information tech companies have been busy developing solutions that monitor and track practically every movement a resident makes. Some of the solutions employ visible, wearable tech. Others are practically invisible.
“CMS is always looking for ways to keep residents safer than just making sure they're not wandering around outside the facility, says Maayan Wenderow, director of marketing for EarlySense Inc., which markets a continuous patient monitoring solution.
Wandering management today has evolved, in part, by adopting many of the techniques used in healthcare emergency preparedness, which uses a system of drills and sophisticated information technology to achieve around-the-clock situational awareness.
“I think the most important thing is increased awareness around the safety risks,” Wenderow says. “Most facilities have initiatives and protocols in place to assist with fall prevention, pressure ulcer prevention and wandering residents.”
One popular method is the Situation, Background, Assessment and Recommendation (SBAR) Toolkit, adapted from the U.S. Navy by Kaiser Permanente. “SBAR is an effective and efficient way to communicate important information and is used by the nursing team to communicate clinical information about a resident's status to a physician or a nurse practitioner,” Wenderow adds.
“All new construction projects include some form of safety solution between wander management, access control and video surveillance,” Jansen says. “We also see more of our customers with existing communities looking to upgrade their current technology as the quality of offerings improve and become more financially attainable.”
The biggest benefit from today's offerings is the ability to customize technology to fit individual residents. “Facilities can create system configurations that are specific to their needs and the needs of their residents,” says Brad Hyder, marketing manager for TekTone Sound and Signal Manufacturing Inc. “For most facilities, that includes providing the patient with the ability to initiate the call when they know that they need help. Facilities with wander management systems also maintain the flexibility to allow residents to wander freely throughout the facility while creating alerts for doors or hallways that may put the resident at risk.”
Adds Larson, “Technology plays a huge role in improving safety measures, and the level of monitoring is generally very flexible. For instance, most call pendants and wander transmitters don't track residents unless the system has been activated. If a resident pushes their pendant button for assistance in the day room, an alarm with their identification and location will be created in the software. In another case, a memory care patient wearing a transmitter may attempt to exit through a monitored door or may loiter near a door. With a wander management system configured with ID, an alarm would be generated with the resident's ID and the location of the alarm event.”
Larson predicts sensor-based solutions may one day become so sophisticated that they could generate predictive alerts on changes in residents' abilities to perform activities of daily living.
The personal touch
No matter how sophisticated the technology gets, the “man or woman behind the curtain” still will be a critical part of the solution. As Wenderow asserts, “technology is only a tool in the hand of the clinicians, and to achieve safety goals, there needs to be a cultural change and teams have to work together to accomplish it.”
“It's impossible for staff members to watch over every individual all the time, but technology can,” Elder adds. “Our philosophy has always been that it is aware and engaged caregivers who keep residents safe.”
Laura Wasson, director of business development for Tech Electronics, believes technology is one solution that works in tandem with staff to ensure resident safety. Still, “the staff is responsible for caring for multiple residents at a time, leaving room for human error,” she says. “Technology is constant.”
“The average out-of-court settlement for a wandering lawsuit is $400,000, so staff members play a particularly vital role in protecting the residents that they care for,” Hyder adds. “Technology is absolutely essential to providing resident safety, but staff members must remain ever attentive.”
“The now often-used phrase of “see something, say something” never has been more important than in the realm of resident wandering and elopement,” Jansen says. “Staff engagement is absolutely essential in creating and sustaining a truly safe environment.”